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Evidence summaries

Gabapentin or Pregabalin for the Prophylaxis of Episodic Migraine in Adults

Gabapentin is not efficacious for the prophylaxis of episodic migraine in adults but adverse events are common. There are no studies on pregabalin in episodic migraine. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 6 RCTs with a total of 1009 subjects with migraine. Five trials were on gabapentin and one trial on its prodrug gabapentin enacarbil; no reports on pregabalin were identified. All six trials had a parallel-group design. The median duration of the treatment phase of the included trials was 12 weeks. One trial each of gabapentin 900 mg (n=53), and gabapentin titrated to 1200 mg (n=63) and 1800 mg (n=122) failed to show a statistically significant reduction in headache frequency when compared to the placebo group, whereas one trial of gabapentin titrated to 1800 to 2400 mg (n=113) demonstrated a small but statistically significant superiority of active treatment (MD -0.80; 95% CI -1.55 to -0.05). The pooled results do not demonstrate a significant difference between gabapentin and placebo (MD -0.44; 95% CI -1.43 to 0.56; 4 trials, n=351). One trial of gabapentin titrated to 1800 mg (n=122) failed to demonstrate a significant difference between active treatment and placebo in the proportion of responders (OR 0.97; 95% CI 0.45 to 2.11), whereas one trial of gabapentin titrated to 1800 to 2400 mg (n=113) demonstrated a small but statistically significant superiority of active treatment for this outcome (OR 2.79; 95% CI 1.09 to 7.17). The pooled results of these two studies (OR 1.59; 95% CI 0.57 to 4.46; n=235) do not demonstrate a significant difference between gabapentin and placebo. Comparisons from one study (n=135) suggest that gabapentin 2000 mg is no more effective than gabapentin 1200 mg. One trial of gabapentin enacarbil (n=523) failed to demonstrate a significant difference vs. placebo or between doses for gabapentin enacarbil titrated to between 1200 mg and 3000 mg with regard to proportion of responders; there was also no evidence of a dose-response trend. Five most prevalent adverse events with gabapentin were asthenia/fatigue, dizziness, flu syndrome, somnolence, and abnormal thinking.

Clinical comments

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References

  • Linde M, Mulleners WM, Chronicle EP et al. Gabapentin or pregabalin for the prophylaxis of episodic migraine in adults. Cochrane Database Syst Rev 2013;6():CD010609. [PubMed]

Primary/Secondary Keywords